A bleak reminder of the uncertain future of Medicare Locals comes to Croakey from two separate sources.

Shadow Health Minister, Peter Dutton,  says the Coalition would be prepared to target the jobs of an estimated 3,000 people employed by Medicare Locals, as part of budget savings measures.

His comments come as a NSW Local Health District board member, who wishes to remain anonymous, tells Croakey:  “Medicare Locals at present are vulnerable.”

That’s because, he says, they are not yet involved in any meaningful way in service delivery funded through their budgets.  That is a view many MLs would contest, as many of their staff are directly involved in providing and/or arranging care for patients.

Mr Dutton has told Croakey  “With increasing pressure on the health budget, the Coalition is working with a range of stakeholders on ways to rationalise bureaucracy that has ballooned under Labor so that more resources can be redirected to patient services.

“They may be well intentioned, but we can’t afford Labor’s dozen new bureaucracies with over 6,000 people in the department and portfolio agencies and over an estimated 3,000 people employed across Medicare Locals.

“We support a co-ordinated primary care approach, but we don’t support the way Labor has implemented Medicare Locals. The Coalition will detail its plan for primary care in the run up to the next election,” says Mr Dutton.

The Local Health District board member says ML funding “is almost completely for administration”. They were the equivalent of an Area
Health Service Administration responsible for hospitals, but did not have any clinical services to administer.

“No-one would notice shutdown”

“Until they start providing or funding clinically important services that the community needs, no-one would notice any difference if they
were shut down by an incoming coalition government except the people at the MLs who lose their jobs,” he said.

It should be remembered that the Australian Divisions of General Practice had refused to wind up, so whatever MLs were doing could
easily be assigned to a division at the stroke of a ministerial pen.

The board member says that MLs “have not yet engaged with local hospital networks in a structural way. Any co-operation is as a result if individual initiatives.”

LHDs in NSW, for example, were not required to co-operate with MLs, and had no funding provided to build models of care crossing the “Great Wall” separating what was done in hospitals, and what was done in primary care (95% of which was private General Practice).

The National Health and Hospitals Reform Commission “nirvana” of a unified health system administered at a regional level to meet local needs would remain an aspiration rather than a plan until State and Commonwealth governments agreed to cede their respective governance and fiscal domains to a single funding model, the board member said.

Will Canberra let them be local?

But health economist and public health advocate, Professor Gavin Mooney, has strongly supported the MLs, citing Professor Stephen Leeder’s article in Croakey.

“What people with chronic problems need to hear … is how services will be organised for them, not the other way round, in future,”
Professor Leeder wrote.

“Right on Steve!” says Professor Mooney.

“This is the challenge of Medicare Locals – not easy but about time in PHC. Health services are first and foremost social institutions
and MLs at last and at least recognise that.

“Australia previously struggled in primary care with the all too many, all too small and all too resource poor “Divisions’ (almost as bad a name as Medicare Locals!).

“At least the philosophy behind MLs is right. And if the social determinants of health are going to take off in Australia – and isn’t it about
time? – the MLs are the bodies to lead that.

“My main worry on MLs is simply: will Canberra really let them be ‘local’?

(It was her predecessor who gave them the unfortunate name but can Tanya Plibersek now change the name please? I phoned one today and got an automated message saying in essence “Don’t come to us for your Medicare money, ring XXXX”!)

Declaration: Mark Metherell has been commissioned by the Australian Medicare Local Alliance to write a publication about the work of  Medicare Locals.

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